title: A comparative cost-analysis of initiating pregabalin or SSRI/SNRI therapy in benzodiazepine-resistant patients with generalized anxiety disorder in Spain.
abstract: OBJECTIVE
  To compare the relative healthcare costs, from the perspective of the Spanish National Healthcare System (NHS), of initiating treatment with either pregabalin, or SSRI/SNRI, as add-on therapies, in patients with generalized anxiety disorder (GAD), who are resistant to benzodiazepine-based therapy (BR).
  
  
  METHODS
  BR out-patients with GAD (DSM-IV) who were included in a 6-month, prospective, multicentre, observational cohort study were selected for this post-hoc economic analysis. BR was defined as insufficient response, with persistence of symptoms of anxiety (HAM-Anxiety scale≥16), after a 6-month course of benzodiazepines. Patients had not been previously exposed to pregabalin or SSRI/SNRI. Healthcare resource utilization (drugs, medical visits, hospitalizations, etc.) associated with GAD was collected at baseline and end-of-trial visits. Related costs were estimated at each visit and adjusted changes were compared using ANCOVA.
  
  
  RESULTS
  A total of 128 patients with refractory GAD were treated with pregabalin and 126 SSRI/SNRI. Compared with SSRI/SNRI, pregabalin was associated with significantly lower percentage of benzodiazepines users; 57.0% vs 87.3%, p<0.001, and greater reduction in medical visits; -15.1 vs -13.0, p=0.029. Mean total healthcare resource utilization costs decreased significantly in the pregabalin cohort only; -289 (p=0.003), although six months costs were not significantly different in both groups; 977 vs 822, respectively.
  
  
  CONCLUSIONS
  Initiating treatment with pregabalin was associated with significant reduction in medical visits and total health care resource costs of GAD compared to SSRI/ SNRI in BR patients in the Spanish NHS setting. Compared with SSRI/SNRI, pregabalin therapy was accompanied by significantly less percentage of patients on concomitant benzodiazepines therapy.
authors.affiliation: Servicio de Psiquiatría, Hospital Clínico San Carlos Universidad Complutense de Madrid CIBERsam, Madrid, España. jcarrasco.hcsc@salud.madrid.org
authors.forename: José L
authors.initials: JL
authors.lastname: Carrasco
authors.forename: Enrique
authors.initials: E
authors.lastname: Álvarez
authors.forename: José M
authors.initials: JM
authors.lastname: Olivares
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000191:economics*; D001569:Benzodiazepines / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin; D011446:Prospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D013030:Spain; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D018759:Adrenergic Uptake Inhibitors; D001569:Benzodiazepines; D000069583:Pregabalin; D017367:Selective Serotonin Reuptake Inhibitors; D005680:gamma-Aminobutyric Acid